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Bacterial Meningitis in Children Dr Rajesh Kumar MD (PGI), DM (Neonatology) PGI, Chandigarh, India Rani Children Hospital, Ranchi. RELAPSING FEVERS A group of acute infections caused by arthropod born spirochetes of the genus Borrelia.
Meningitis Jerry Carley MSN, RN, CNE University of Southern Nevada Adult Health II Summer 2010 NURSE Adult Health II Neurological Diseases.
ACUTE PNEUMOCOCCAL AND MENINGOCOCCAL MENINGITIS Learning Objectives Introduction Epidemiology History and PresentationHistory and Presentation Examination. Background and Objective: Acute exacerbation of chronic obstructive pulmonary disease (COPD) leads to increased morbidity, mortality and requirement of invasive mechanical ventilation (MV). Tachycarida, cyanosis, diaphoresis, chest pain, peripheral vasodilatation with hypotension. 2)Current: standards should be reviewed and revised or changed as necessary so that they reflect the changes in medical sciences and technology, as well as changes in the socio-economic condition of the community and in the values and expectations of the people. 3)Good standards should be specific, objective, and preferably expressed in quantitative terms, thus to leading to reliability of measurement. 2- Written documentation: (recording critical incidences – completing performance review form). It comprises a description setting or background and the incident, and interpretation and recommendations may be included. General Characteristics of the Staphylococci Nonmotile, gram- positive cocci arranged in irregular clusters.
Alternative Names l Onyong- Nyang Fever l West Nile Fever l Break Bone Fever l Dengue like Disease.
All rights reserved Principles of Asepsis PowerPoint® presentation to accompany: Medical Assisting Third Edition.
Predictors of requirement of mechanical ventilation in patients with chronic obstructive pulmonary disease with acute respiratory failure. The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: A long term follow up study.
Predictors of need of mechanical ventilation and reintubation in patients with acute respiratory failure secondary to chronic obstructive pulmonary disease. Conservative and respirator treatment of acute respiratory insufficiency in patients with chronic obstructive lung disease.
Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Relationship between arterial blood gases and spirometry in acute exacerbations of chronic obstructive pulmonary disease. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure.
Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. Our Team, headed by Mike Cadogan & Chris Nickson, consists (mostly) of emergency physicians and intensivists based in Australia and New Zealand. This impairs breathing, thereby reducing the amount of O2 in the capillaries that supply the lungs. When the work requirement of the right ventricular exceed its capacity, right ventricular failure and decrease in cardiac output followed by decrease BP and development of shock and pulmonary infarction. Produce 9 Kcal in complete oxidation ( It Produce more Energy because of more Hydrogen atoms to Oxygen atoms and the chief energy in the adipose tissue). On hydrolysis Triacylglycerol   produce glycerol and fatty acids as it is an esrer of fatty acid and glycerol. The most important limitation is that they may conceal actual poor performance even though the standards have been achieved.
It means that the method of assigning value must explicitly (spelled out) and clearly state what is exactly to be measured, when, and where.

If the deviation is acceptable, or its cause is uncontrollable, activities continue with no intervention (Acceptance control loop). Late feedback may result in a problem being attacked after it has already cured itself, or worse, it may allow a problem to get so out of control that more drastic means of intervention must be employed. Changes and unforeseen circumstances require that judgment, common sense, and flexibility be used in control systems. Therefore, effective control systems should consider training managers who are going to implement and use them. As far as possible, the worker and the immediate supervisor should be involved in the monitoring and correction processes.
The super control system is asked to intervene only when the manager calls for help, or when the whole process (including the manager and the control system) appears not to be functioning properly. This includes respect for the need to have control, belief in the standards of the performance, a feeling of responsibility for maintaining control, and a feeling that they do have the ability to intervene when necessary. It is advisable to make several brief observations over a time span to allow for  temporary Variables and to identify patterns of behaviors. Checklists are mostly for tangible variables, Such as inventory of supplies, and may be used to evaluate nursing skills also. It locates the behavior at a point on a continuum and notes quantities and qualitative abilities.
Materials and Methods: Clinical symptomatology, demographic profile, biochemical parameters including renal functions, liver functions and acid base parameters, and acute physiology and chronic health evaluation II (APACHE II) score at the time of admission were recorded in 100 patients of COPD exacerbation. This is important for standardization, which means that similar results should be obtained when the same measuring instrument is used by the same person or by different persons. The consideration of when feedback is “late” depends on the process being controlled and the speed with which intervention can be successfully employed.
The numerical rating scale usually includes numbers against which a list which a list of Behaviors are evaluated. FETUGA2 Diphtheria is an acute, toxin-mediated disease caused by Corynebacterium diphtheriae. Various parameters were compared between patients in whom MV was required with those managed with medical therapy.
Well-equipped critical care beds are at a premium, and the available numbers fall well short of the number of patients that could potentially benefit by admission to these units. Such a scenario makes appropriate utilization of resources, including the critical care beds, imperative.
It stands to reason in such a scenario to offer intensive care unit admission to the patients that are at a higher risk of developing complications, including need of MV. Apart from ensuring close monitoring with prompt intervention as needed, such an approach may even aid in obviating the need of MV in some of these patients. The current study was conducted to identify independent predictors of need of MV in patients with exacerbation of COPD admitted to a tertiary care center.
All patients admitted with a primary admitting diagnosis of acute exacerbation of COPD were eligible for inclusion. All patients had to have a prior confirmed diagnosis of COPD on the basis of fixed airway obstruction on spirometry.
Findings on clinical examination including heart rate, respiratory rate and mean blood pressure were recorded. Acute physiology and chronic health evaluation II (APACHE II) score was recorded at the time of admission. Developments of other complications in the form of acute respiratory distress syndrome (ARDS), sepsis and various types of organ failure were also documented. Days on ventilator were recorded for all patients.The patients were managed by a team of physicians. The management strategy was decided by the treating physician, and it was individualized for each patient according to the patient's clinical status.
All patients received regular nebulized bronchodilators including salbutamol, ipratropium bromide and intravenous steroids. Endotracheal intubation was performed for standard indications like respiratory arrest, deteriorating level of consciousness, exhaustion, progressive hypoxemia, hypercapnia and deteriorating acidemia despite maximal level of medical treatment.
This study was a prospective observational study; therefore, no new drugs or devices were used and no new investigations were carried out other than those that were required during the course of disease management and which were standard of care and were recommended by various medical bodies for managing such patients.

Descriptive analysis consisted of mean with standard deviation and range for various parameters. The study group was divided on the basis of primary outcome of the study (need of intubation). Various parameters were compared between the two groups to identify the predictors of intubation. Continuous variables were analyzed using Student's t-test whereas Fisher's exact test was used to compare the ordinal variables.
Parameters found to be significant in univariate analysis were evaluated using multivariate logistic regression analysis to determine independent predictors of need of MV. Majority of the patients (90%) had history of exposure to risk factors for the development of COPD.
Forty-one patients had clinical and ECG changes suggestive of cor-pulmonale while chest X-ray done at the time of admission showed infiltrates in 44% of the patients. Among the eight patients initially managed with NIV, four had grade III and two each had grades IV and II premorbid functional state.Ten patients had evidence of sepsis, but none had ARDS at the time of admission. The course of COPD is marked by progressive deterioration in lung function and functional status punctuated by episodes of acute exacerbation.
Several patients with exacerbation of COPD presenting to our medical center are unable to get admitted due to a perennial paucity of beds. Many such patients who are stable enough to be transferred are referred to other institutions, thereby leaving behind mostly the sickest and unstable patients for admission to our Institute.
A high mean APACHE II score at admission and a much higher incidence of need of MV are reflective of the same. This fact also makes the current study unique from earlier studies by showing the predictive capability of commonly used predictor variables such as APACHE II score and simple physiological measurements among patients with the most severe forms of COPD exacerbation.Patients with higher first day APACHE-II score, acidemia, hypercarbia and worse premorbid functional status were more likely to need MV on multivariate analysis. Arterial pH has been reported as independent predictor of need of MV in earlier studies as well. They also described a threshold pH below which the rate of intubation was remarkably high in COPD patients with acute exacerbation with respiratory failure. They also noted that in more acidemic patients, there was a shorter time gap between the presentation of patient to hospital and the time of intubation.
PaCO 2 was also found to be significantly higher in patients requiring invasive MV in a study by Vitacca et al. Besides ventilation perfusion mismatch, development of respiratory muscle fatigue due to tachypnea and decreased skeletal muscle mass and alveolar hypoventilation also contribute to raised PaCO 2 and more acidotic pH.
Further, in the study by Hoo et al., [11] mechanically ventilated patients had significantly higher APACHE-II score. It indicates the condition of the patient in terms of severity of dyspnea, level of independence in doing activities of daily living reflecting potential severity of underlying COPD and other associated conditions. In a study by Menzies et al., premorbid functional status was more strongly associated with outcome measure than any other single measure. According to them, this may reflect the limitations of current physiologic measures in assessing the impact of disease fully. This is an intriguing finding and suggests that need of MV is as much influenced by the underlying chronic disease severity as by the acute insult of the exacerbation.
Further, the current study also validates the predictive capability of commonly used variables in a sicker group of COPD patients. The biggest limitation of this study was the low use of NIV, as availability of the NIV was limited at the time the study was conducted. The logistics and feasibility regarding NIV significantly impacted the decision to institute NIV. Another limitation of this study is inclusion of patients with pulmonary infiltrates.In conclusion, underlying disease severity as assessed by premorbid functional status and APACHE-II score, and the acuity of respiratory system decompensation as assessed by the admitting arterial pH and PaCO 2 are independent predictors of need of MV in patients with exacerbation of COPD.

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